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B. J. Lee, S. Ference, D. M. Peereboom, A. D. Singh; Primary Central Nervous System Lymphoma: Analysis of Recurrence Patterns. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1580.
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© ARVO (1962-2015); The Authors (2016-present)
To describe recurrence patterns in patients with large B cell primary central nervous system lymphoma (PCNSL) treated with methotrexate using blood brain barrier disruption (BBBD) technique.
We reviewed all immunocompetent patients who received methotrexate with BBBD for PCNSL from 2000 to 2006. Only patients with isolated brain involvement at presentation who achieved a complete response (CR) were included. Recurrence patterns were classified as brain, leptomeningeal, or intraocular.
Of the 11 patients who received BBBD treatment and achieved CR initially, 9 had recurrences. Five patients (55%) had recurrence in the brain only with a mean interval between last BBBD treatment and recurrence of 15 months and a range of 1 to 35 months. Four patients (44%) had various combinations of simultaneous intraocular, brain, or leptomeningeal recurrence. The interval between last BBBD treatment and recurrence ranged from 2- 32 months with a mean of 20 months. All three patients with intraocular recurrence presented with complaints of floaters and hazy vision prior to knowledge of recurrence elsewhere. Further workup through MRI of the brain and CSF cytology revealed involvement elsewhere.
Our results emphasize the important role of an ophthalmologist in periodically evaluating patients with PCNSL, even those with initial CR to BBBD treatment. There should be a low threshold for suspecting recurrence in the follow up because the complaints may be subtle.
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